Working together to address Multiple Exclusion Homelessness

Michelle Cornes, Louise Joly, Jill Manthorpe, Sue O’Halloran, Rob Smyth

King’s College London, University of Cumbria, Look Ahead Housing & Care

Presentation by Sue O’Halloran to the

International Symposium on Contemporary Issues in Public Health and Social Welfare

Yerevan, Armenia, February 2011

Objectives of the study

describe the varied nature of the workforce dealing with multiple exclusion homelessness

Show how interprofessional collaboration helps us to manage the interfaces between homelessness and other aspects of deep social exclusion

Find out how interprofessional collaboration

can best work to prevent multiple exclusion homelessness.

The Common Assessment Framework

The Common Assessment Framework (CAF) is the method that the relevant agencies must work within to deliver health and social care to the individual.

It states that, in any geographical locality, there must be shared understanding and agreement, among different agencies and professionals, around procedures for information sharing and coordination.

It requires that the care management be led by a ’lead worker’, who can be a single person or possibly a multidisciplinary team of professionals who meet to coordinate the individual’s care and support needs

Focus Groups - Case Vignettes

Looking at:-the causal routes into homelessnessthe relationship between homelessness

and deep social exclusionthe degree of overlap between various

deeply socially excluded groupsthe outcomes of interprofessional

interventions and finding best practice.

An example from the study

A man with a long-standing alcohol problem… has suffered ahead injury and fits…also has a chronic infection in one leg

He is street homeless… pushed out of one local authority… recently on remand for assaulting a policewoman … when he came out of prison, he came into one of the hostels.

Hostels couldn’t manage him…he threatened the hostel staff and he was evicted… he is back on the street…doesn’t want help with his substance misuse …so he doesn’t meet threshold for help from the drug services

Fieldwork

Three different settings a housing support & homeless prevention

service for offenders, in a remote and sparsely populated rural area.

a rent deposit (bond guarantee) scheme based in a metropolitan town

an inner-London hostel

Three organisations hosted the fieldwork Fieldwork involving 13 vignette focus groups and

23 individual interviews (to date, work is continuing)

Example (continued)

He has a degree of physical disability…but he won’t meet the threshold for ordinary residential care…he has a degree of cognitive impairment but we are not sure how much…probably not too much so he doesn’t fit the mental health criteria… and he is a very difficult person in his behaviour

So if you add it up he has got multiple needs but there isn’t actually a service that meets his needs… so he remains on the street.’

(Testimony from a Housing Support Worker)

Exclusions

However, remember that exclusions (‘gate keeping’) are rooted in:- ever tightening eligibility criteria and high case loads extend across adult social

care

and are not restricted to people with experience of multiple exclusion homelessness.

Compartmentalisation

The process of compartmentalising needs in terms of separate specialist referrals for

drugs, alcohol and mental health problems

is a central feature of much ‘joint working’ in multiple exclusion homelessness and can compound exclusion

Tell me about Sam’s support plan..

With Sam you have got the behaviour, the paranoia… the family dynamics or history… and the addiction which always seems to be the stumbling block,

alcohol use and the rent arrears as usual… all the indicators of someone having a chaotic lifestyle

Last time he was here in the hostel… he totally lost the plot.. and went about dressed as a vampire most of the time…

Tell me about Sam’s support plan..

So there was so much wrong with him really… and the relationship with his girlfriend… there were issues of domestic violence on top of that

All of which it made it even more confusing… and made Sam even more difficult to work with

(Testimony from a Hostel Worker)

Emerging results

Our key finding is that duplication across the system and a

lack of ‘joined-up’ working means that people are being bounced

between different parts of the system or left largely out in the cold …devoid of

proper care

Emerging results

in most cases housing support workers are providing much more than low intensity ‘housing related support’

as care management increases, housing support workers are filling the vacuum…

…left by the retreat of social workers from ‘direct work’ with adults

Conclusion – 3 ways forward

Our findings indicate three ways forward

Firstly:- we need, in each locality, clear leadership and

commitment at the highest levels to secure - across health, housing and adult

social care - integrated commissioning that will ensure the effective implementation of the ‘Common Assessment Framework’ (CAF).

Conclusion – 2nd key finding

Secondly,

local homeless forums must lobby hard to ensure that local services are available to all adults i.e. including those with experience of multiple exclusion homelessness.

Previously dedicated funds are becoming absorbed within mainstream local authority budgets - the forums need to check that people with experience of multiple exclusion homelessness are not ‘assessed out’ of services

Conclusion – 3rd key finding

Thirdly, we need to re-evaluate the job role of the

housing support worker,recognising that the role has extended

well beyond the provision of low intensity support,

and provide the training and management support that these workers need

The final challenge

to secure a conceptual shift:- away from ‘multi-professional working’ towards ‘integrated interprofessional working’ so that we can reintegrate ‘homeless people’

back into the adult population in need of health and social care

and provide them with the integrated care they need